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Questions and Answers
Which adverse effect is commonly associated with calcium-channel blockers?
What is the primary mechanism of action for beta-blockers in the treatment of angina?
Why are beta-blockers contraindicated in Prinzmetal’s angina?
Which of the following agents is known to facilitate coronary blood flow and myocardial oxygen supply?
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Which side effect is NOT associated with calcium-channel blockers?
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What mechanism does the drug Ranolazine primarily target for treating angina?
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Which is a common side effect of vasodilatory medications?
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The mechanism of action of aspirin in the context of angina involves which of the following?
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What primarily leads to angina pectoris?
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Which condition is NOT associated with diminished blood supply leading to angina?
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Which factor does NOT contribute to increased cardiac muscle demands leading to angina?
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Where does the pain associated with angina typically radiate?
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What is a common provocative cause of angina pectoris?
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What is one symptom that may occur alongside angina pain?
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What substance accumulation results from myocardial hypoxia in angina?
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Which of the following is not a clinical manifestation of angina pectoris?
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Which medication is indicated for the treatment of lethal arrhythmias in myocardial infarction?
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What is the role of furosemide in congestive heart failure?
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Which condition is characterized by decreased cardiac output and elevated pulmonary artery pressure?
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What is a primary aim of treatment during an acute myocardial infarction?
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Which medication is used to manage severe pain during an acute myocardial infarction?
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Which type of drug is indicated for improving myocardial contractility in cardiogenic shock?
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What class of medication may prevent embolic complications following myocardial infarction?
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Which option is an action of morphine in patients with acute myocardial infarction?
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Which of the following is NOT a recognized risk factor for myocardial infarction?
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What is the most common description of chest pain in myocardial infarction patients?
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What is the preferred agent for rapid control of ventricular fibrillation?
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What percentage of myocardial infarction patients may experience no pain, referred to as 'Silent MI'?
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Which of the following vasodilators is commonly used in cardiogenic shock?
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What condition can excessive doses of lidocaine lead to?
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Which laboratory study is considered the standard for detecting myocardial necrosis?
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What is the typical time frame for Troponin I to become detectable in serum after an acute myocardial infarction?
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Which of the following statements is true regarding thrombolytic agents?
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What is the primary purpose of using an intra-aortic balloon pump?
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Which of the following findings is associated with patients who have an acute myocardial infarction?
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In the context of myocardial infarction, which enzyme is primarily used to estimate infarct size?
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Which medication should be given orally within the first 24 hours after an anterior myocardial infarction?
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What is the source of urokinase used in thrombolytic therapy?
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Which statement about the LDH isoenzymes is correct during myocardial infarction?
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Which of the following medications is NOT mentioned as a way to limit the size of an infarct?
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Study Notes
Angina Pectoris
- Characterized by episodes of chest pain or discomfort caused by myocardial ischemia.
- Etiology:
- Imbalance between blood supply and oxygen demand to the heart muscle.
- Diminished blood supply:
- Narrowing of coronary arteries due to atherosclerosis (most common).
- Low cardiac output conditions (e.g., aortic stenosis, mitral stenosis).
- Coronary ostial stenosis (e.g., syphilis).
- Diminished quality of blood supply:
- Anemia, especially in patients with narrowed coronary arteries.
- Cyanotic conditions (e.g., lung diseases).
- Increased cardiac muscle demand:
- Ventricular hypertrophy.
- Thyrotoxicosis.
- Pathogenesis:
- Myocardial hypoxia leads to accumulation of metabolites, stimulating nerve endings and causing pain.
- Pain impulses transmitted through sympathetic fibers to the upper thoracic spinal segments.
- Clinical Manifestations:
- Pain typically starts retrosternally and radiates to the left shoulder, inner arm, elbow, and little finger.
- Pain may radiate to both shoulders, neck, jaw, or teeth.
- Pain is related to provocative causes (e.g., exercise, emotions, cold, tachycardia, hypoglycemia) and relieved by rest or nitroglycerine.
- Associated symptoms: sweating, dizziness, fear of death, dyspnea.
Angina Treatment
-
Nitrates (e.g., nitroglycerine):
- Mechanism: Vasodilation, reducing preload and afterload, improving myocardial blood flow.
- Side Effects: Headache, hypotension, reflex tachycardia.
-
Beta-Blockers (e.g., propranolol, metoprolol):
- Mechanism: Reduce heart rate and contractility, decreasing myocardial oxygen demand.
- Contraindications: Prinzmetal’s angina.
-
Calcium Channel Blockers (e.g., nifedipine, verapamil):
- Mechanism: Vasodilation, reducing systemic vascular resistance and improving coronary blood flow.
- Side Effects: Vasodilation, negative inotropic effects, conduction disturbances.
-
Potassium Channel Activators (e.g., nicorandil):
- Mechanism: Activation of potassium channels and nitrate-like activity.
-
Platelet Inhibiting Agents (e.g., aspirin):
- Mechanism: Inhibition of platelet aggregation, reducing the risk of thrombus formation.
Acute Myocardial Infarction (AMI)
- Defined as the death of myocardial tissue due to prolonged ischemia.
- Risk Factors:
- Age
- Male gender
- Smoking
- Hypercholesterolemia
- Hypertriglyceridemia
- Diabetes mellitus
- Uncontrolled hypertension
- Family history
- Clinical Picture:
- Severe chest pain described as tightness, pressure, or squeezing.
- Pain may radiate to the jaw, neck, arms, back, or epigastrium.
- Left arm is affected more frequently than the right arm.
- Silent MI can occur without pain, especially in diabetics and elderly.
- Accompanied by sweating, shortness of breath, nausea, vomiting, restlessness, anxiety, lightheadedness, syncope, cough, wheezing.
- Patients may appear pale, sweaty, gray, and have a fever.
AMI Diagnosis and Investigation
- ECG:
- Q wave: Broad and deep.
- ST-segment depression or T-wave inversion.
- Cardiac Enzymes (e.g., CK, Troponin I, LDH, AST):
- Assess myocardial necrosis.
- CK-MB: Specific for AMI.
- Troponin I: Highly sensitive for early detection of myocardial necrosis.
- Imaging Studies:
- Chest radiography: Identifies complications, such as pulmonary edema and CHF.
AMI Complications
- Lethal arrhythmias: Ventricular fibrillation, tachycardia, atrial flutter.
- Congestive heart failure: Left ventricular failure leads to pulmonary congestion.
- Cardiogenic shock: Decreased cardiac output and elevated pulmonary artery pressure.
AMI Treatment
-
Analgesia:
- Sublingual nitroglycerine.
- Morphine (avoid in pulmonary edema).
- Meperidine (alternative for morphine intolerance).
-
Anticoagulation:
- Heparin: Prevents embolic complications.
- Vitamin K antagonists (e.g., warfarin): Long-term anticoagulation.
-
Treatment of Arrhythmias:
- Lidocaine: Preferred for rapid control of ventricular fibrillation.
- Procainamide: Alternative for refractory arrhythmias.
-
Vasodilators (e.g., sodium nitroprusside, nitroglycerine):
- Improve coronary perfusion and reduce ventricular wall stress in cardiogenic shock.
-
Mechanical Circulatory Support (e.g., Intra-aortic balloon pump):
- Improves aortic and coronary blood flow, reducing left ventricular workload in cardiogenic shock.
-
Limitation of Infarct Size:
- Beta-blockers (e.g., propranolol, metoprolol).
- Calcium channel blockers (e.g., verapamil, nifedipine, diltiazem).
- Nitrates.
- ACE inhibitors (e.g., captopril) or ARBs (e.g., valsartan, candesartan).
-
Thrombolytic Agents (e.g., streptokinase, urokinase, anistreplase):
- Lyse coronary thrombi, limit infarct size, and reduce mortality.
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Description
This quiz covers the essential aspects of angina pectoris, including its etiology, pathogenesis, and clinical manifestations. Test your understanding of how myocardial ischemia leads to chest pain and the factors involved. Perfect for students in cardiology or related fields.
